For Residents

Intimate partner violence, guns, and the ObGyn

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References

#BreakTheCycle

The 116th Congress convened in January. We have an opportunity to make real gun legislation reform and work to keep our communities and our patients at risk for IPV safer. Tweet your representatives with #BreakTheCycle, and be on the lookout for important legislation to enact real change.

To sign the open letter from American Healthcare Professionals to the NRA regarding their recent comments and our medical experiences with gun violence, click here. Currently, there are more than 41,000 signatures.

Screening for intimate partner violence

There are numerous verified screening tools available to assess for intimate partner violence (IPV) for both pregnant and nonpregnant patients. Many recommended tools are accessible on the Centers for Disease Control and Prevention (CDC) website: https://www.cdc.gov/violenceprevention/pdf/ipv/ipvandsvscreening.pdf. In our office, the tool most commonly used is a 3-part question assessing domestic violence and IPV. It is important to recognize IPV can affect everyone—all races and religions regardless of socioeconomic background, sexual orientation, and pregnancy status. All patients deserve screening for IPV, and it should never be assumed a patient is not at risk. During an annual gynecology visit for return and new patients or a new obstetric intake visit, we use the following script obtained from ACOG’s Committee Opinion 518 on IPV1 :

Because violence is so common in many women’s lives and because there is help available for women being abused, I now ask every patient about domestic violence:

1. Within the past year (or since you have become pregnant) have you been hit, slapped, kicked, or otherwise physically hurt by someone?

2. Are you in a relationship with a person who threatens or physically hurts you?

3. Has anyone forced you to have sexual activities that made you feel uncomfortable?

If a patient screens positive, we assess their immediate safety. If a social worker is readily available, we arrange an urgent meeting with the patient. If offices do not have immediate access to this service, online information can be provided to patients, including the National Resource Center on Domestic Violence (https://nnedv.org/) and a toll-free number to the National Domestic Violence Hotline: 1-800-799-7233. Additionally, we ask patients about any history of verbal, physical, or sexual violence with prior partners, family members, acquaintances, coworkers, etc. Although the patient might not be at immediate risk, prior experiences with abuse can cause fear and anxiety around gynecologic and obstetric exams. Acknowledging this history can help the clinician adjust his or her physical exam and support the patient during, what may be, a triggering experience.

As an additional resource, Dr. Katherine Hicks-Courant, a resident at Tufts Medical Center, in Boston, Massachusetts, created a tool kit for providers working with pregnant patients with a history of sexual assault. It can be accessed without login online under the Junior Fellow Initiative Toolkit section at http://www.acog.org.

References

1. American College of Obstetricians and Gynecologists. Committee Opinion No. 518: intimate partner violence. Obstet Gynecol. 2012;119:412-417.

If you, or someone you know, needs help, please call The National Domestic Violence Hotline at 1-800-799-7233.

Share your thoughts! Send your Letter to the Editor to rbarbieri@mdedge.com. Please include your name and the city and state in which you practice.

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